Factors Determining Consumer Acceptance of Biofortified Food: Case of Zinc-Fortified Wheat in Pakistan's Punjab Province.

Zinc (Zn) is a fundamental micronutrient required by all living organisms. Zn deficiency among children under 5 years, pregnant, and child-bearing women has been identified in developing countries such as Pakistan. Biofortified crops can increase micronutrient levels and decrease deficiencies. Meanwhile, consumer acceptance is essential, given that genetic alterations can occur during biofortification, resulting in changes in sensory traits and the quality of grains. Therefore, the present study focuses on the determining factors for consumer acceptance of Zn-biofortified wheat., an experimental survey was conducted to achieve the study's objectives. Qualitative and quantitative data were collected and analyzed from 203 respondents in the Punjab province. The results regarding sensory perceptions revealed that people attached great importance to the appearance of the chapati prepared with Zn-biofortified wheat. Therefore, they were willing to purchase Zn-biofortified wheat when asked to choose between the conventional wheat and the Zn-biofortified wheat. Moreover, the probit model illustrates that the level of education in the family and having young children aged under 5 years in the household positively impacted the acceptance of Zn-biofortified wheat among the participants. The findings suggest that there is significant scope for promoting Zn-biofortified wheat in the country. It is also imperative to ensure its availability across various regions so that households with weak purchasing power can buy and address their Zn deficiency. Furthermore, policymakers could introduce reforms targeting business communities for food management, keeping Zn-biofortified wheat in the priority stream.

Rising incidence of obesity in Saudi residents. A threatening challenge for the surgeons.

OBJECTIVE: Obesity is thought to correlate very strongly with individuals general lifestyles. This study was conducted to determine whether lifestyle patterns were potential risk factors for morbid obesity in Saudi residents. METHODS: This descriptive cross-sectional study was conducted in Unaizah City, Qassim Region, Kingdom of Saudi Arabia, over a 1-year period from March 2013 to March 2014. The study included 646 residents from the general public of Unaizah who were selected by convenient sampling at a mall and a public sector university, regardless of age and gender, and were given questionnaires regarding the details of their lifestyle patterns. The studied variables included demographic details, dietary habits, physical activity, occupation, body mass index, and unhealthy behavioral habits. The data were collected and statistically analyzed using SPSS version 20. RESULTS: The study population had a mean age of 30.13 ± 12.15 years and comprised 202 (31.3%) male and 444 (68.7%) female subjects. The study subjects were students (39.2%), general public included employed (35.3%), unemployed (23.8%), and others (1.7%). Overall, 79.4% comprised Saudi nationals and the majority (48.3%) had a university-level education. A reasonably high proportion of Saudi subjects were found to have sedentary habits and with physical activity levels far below the standard. Obesity was found in 42% of the study population with low physical activity levels and unhealthy dietary habits. Varying proportions of concomitant hypertension, hyperglycemia, and hypercholesterolemia were also observed in these subjects. CONCLUSION: Sedentary habits, low physical activity levels in younger populations, and unhealthy dietary habits are major factors causing obesity in the general public as well as in children and adolescents attending school and university. Serious insight into this problem at the governmental level is needed to improve the overall activity level and avoidance of a sedentary lifestyle by projecting the importance of a healthy lifestyle.

Comparison of the efficacy of standard bariatric surgical procedures on Saudi population using the bariatric analysis and reporting outcome system.

OBJECTIVES: To  compare the efficacy of various standard bariatric surgical procedures using the Bariatric Analysis and Reporting Outcome System (BAROS). Methods: This is a prospective, descriptive analytical study conducted in 2 medical institutions in Saudi Arabia. A total of 270 patients who had different bariatric surgery during the period between March 2010 and December 2012 were included. The data was analyzed and scored against 3 outcomes, excess weight loss, cure or improvement of comorbidities, and quality of life changes. Results: All patients who had different bariatric procedures were included in our study. Seventy-nine (29.3%) underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP), 159 (58.9%) had laparoscopic sleeve gastrectomy (LSG), and 32 (11.9%) had laparoscopic adjustable gastric banding (LAGB). Complete remission of at least one comorbidity was reported in 36% of LRYGBP, 51% in LSG, and 42% in LAGB. While all other patients have improved comorbidities. The BAROS score was good or higher in 78.5% of LRYGBP, 83.6% for the LSG, and 84.4% of LAGB patients. The average excess weight loss was 67.9% in LRYGBP, 75.8% in LSG, and 81.7% LAGB patients. Conclusion: Bariatric surgery provides a substantial reduction in excess weight, improvement and cure of comorbidities, and improvement in quality of life. Standard bariatric procedures have different degrees of outcomes that can be beneficial in selecting appropriate procedure for appropriate indications and patients.

Acute pancreatitis. A more common and severe complication of gallstones in males.

OBJECTIVE: To describe an increased incidence and severity of gallstone pancreatitis in males compared to females. DESIGN METHODS: This is a retrospective observational comparative study conducted at Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, over 3 years from June 2008 to June 2011. The study includes two hundred and thirty seven (237) patients with a mean age of 52.38, Std 13.311,65 (22-87) with 157 (66.24%) females and 80 (33.75%) males who were admitted as acute abdominal pain secondary to gallstones. The patients were mostly diagnosed on ultrasonography and enzyme studies. Demographics and other variables are studied and statistical analysis done on SPSS version 20. RESULTS: More frequent cases of severe acute pancreatitis were observed in males with gallstones (70%) compared to females (P<0.001). The aged people had a high prevalence while males were more likely to develop local and systemic complications. Severity stratification was done based on different criteria's like Ranson's criteria, and APACHEII. Overall mortality was 7.59%. Mortality among males was significantly high (70%, n=16) in our study due to an increased incidence of fulminant course of the disease. CONCLUSION: Contrary to the belief, gallstone associated acute pancreatitis is getting more common in our society and especially so in male population.

Deliberate ingestion of stones causing a diagnostic dilemma. A personal experience.

Deliberate ingestion of foreign bodies is not a new subject especially in our society where such patients are neglected and their problems are rarely investigated properly. These kinds of problems usually have a compulsive driven and complicated elements involved which are very refractory to treatment and are often repetitive. Such a habit is mostly seen in children of very tender age but the situation is more worrisome when you come across adults who are otherwise considered normal but are found to have a deliberate compulsion to ingest funny things like papers, stones, jewelry and other injurious agents which can lead to life threatening complications. A very interesting case of a young girl is presented here which will certainly be beneficial to the surgeons as well as practitioners.

Yield of diagnostic laparoscopy in abdominal tuberculosis: is it worth attempting?

BACKGROUND: Abdominal tuberculosis is extremely common in developing countries such as Pakistan and India. The presentation is varied and nonspecific, making the diagnosis extremely difficult at times. This study was performed to find out the efficacy of diagnostic laparoscopy in establishing the histopathological diagnosis of abdominal tuberculosis. METHODS: An analytical descriptive study of 109 patients with abdominal tuberculosis diagnosed by laparoscopy was conducted over a period of 5 years (between January 2004 and December 2009) in a teaching hospital and in various private hospitals. All patients with vague abdominal symptoms and suspicion of abdominal tuberculosis were admitted and examined thoroughly. Data were collected and statistically analyzed using SPSS version 16. RESULTS: A total of 133 patients with vague abdominal symptoms and an unsettled diagnosis were included in this series, of which 109 (82%) patients were diagnosed with abdominal tuberculosis on laparoscopy. The common symptoms were pain in abdomen, changing bowel habits, loss of weight, and generalized weakness. Clinical examination was not significant, except for anemia in the majority and generalized abdominal tenderness in a few patients. Various tuberculous lesions were detected on laparoscopy. Biopsy of the specimens proved abdominal tuberculosis in 109 patients. Patients were saved from unnecessary laparotomies and were managed on antituberculosis drug therapy. CONCLUSIONS: Diagnostic laparoscopy is an efficient and reliable diagnostic tool for patients suspected with abdominal tuberculosis.

Pattern of acute intestinal obstruction: is there a change in the underlying etiology?

BACKGROUND/AIM: To study the changing pattern of acute intestinal obstruction at a teaching institute. PATIENTS AND METHODS: It is a prospective descriptive study conducted at a teaching hospital during the period from June 2004 to June 2009. All patients with clinical or radiological evidence of acute intestinal obstruction were included in this study regardless of the gender of the patient. Patients below the age of 10 years were excluded from the study. The treatment strategy was planned ranging from conservative treatment to emergency laparotomy after resuscitation and rehydration of the patient. Details of individual patients were recorded on a pro forma sheet and data analyzed statistically on SPSS version 14. RESULTS: A total of 229 patients with acute intestinal obstruction were admitted and treated. The mean age of the study population was 43.08 ± 13.07 years. Postoperative adhesions accounted for 41% (n = 95) of the total cases, followed by abdominal tuberculosis (25%, n = 58), obstructed/ strangulated hernias of different types (18%, n = 42). There was an obvious change in the pattern of etiology of acute intestinal obstruction as the common causes were postoperative adhesions and abdominal tuberculosis instead of obstructed inguinal hernias. CONCLUSION: An increase in the adhesive obstruction and a concomitant decrease in the incidence of obstructed hernias indicate a changing trend towards early operation before it gets complicated. Abdominal tuberculosis is emerging as another common cause of acute bowel obstruction.

Feasibility of early surgical intervention in postoperative entero-cutaneous fistulae.

OBJECTIVES: To study the out come and benefits of an early surgical intervention in postoperative entero-cutaneous fistulae. METHODS: It's a retrospective descriptive study conducted at department of surgery LUMHS from Jan 2001 to November 2008. Two hundred and thirteen (213) post-operative fistulae are included as study subjects while those due to inflammatory bowel diseases, road traffic accidents or following blunt, stab or gunshot abdominal trauma are excluded. An aggressive treatment to build up nutritional status, correction of anaemia and control of sepsis was followed by surgical intervention as soon as the patient's condition permitted. Variables such as type of fistula, out put per 24 hours, duration since development, complications due to fistula, nutritional status, operative procedure, operative time, post-operative complications, total post-operative stay, follow up schedule, outcome. The results were statistically analysed on SPSS-12. RESULTS: A total 213 patients comprising 184 males (85.6%) and 29 (13.5%) females with a mean age of 36.08 years and a range of 64 (78-14) years presenting with post-operative enter-cutaneous fistula are included in the study. Maximum number of patients (171, 79.5%) developed fistula between 4th-6th postoperative day and a vast majority of fistula occurred in the ileum (207, 97.18%) either as a result of anastomotic failure (103), leak from primary closure (99) or from un-noticed missed perforations (5). Of the total number, 24 patients eventually died making a mortality of 11.2%. Early surgical intervention proved life saving (p < 0.001). A strong relation was found pre-operative albumin levels and surgical closure of the fistula (p < 0.001) and associated mortality (p < 0.001). CONCLUSION: High out put fistula is unlikely to close spontaneously on conservative measures. Early surgical intervention can be life saving.

Video-assisted laparoscopic extracorporeal appendectomy versus open appendectomy.

OBJECTIVES: Laparoscopic appendectomy (LA) is categorized into intracorporeal appendectomy (ICA) and video-assisted extracorporeal appendectomy (VAECA). This study is conducted to compare feasibility and effectiveness of video-assisted extracorporeal appendectomy (VAECA) with open appendectomy (OA). PATIENTS AND METHODS: This was a comparative descriptive study conducted at the Department of Surgery of Liaquat University of Medical and Health Sciences (Jamshoro, Pakistan) from June 2003 to November 2007. Two hundred and eighty-three patients of acute appendicitis were included and categorized into two groups: A and B. Group A included 150 (53%) patients operated on by the OA technique, while group B included 133 (47%) patients in whom VAECA was performed. VAECA was accomplished through three ports in the majority of patients (89%), while a few cases (11%) were completed by two ports only. Patients below 10 years of age and with suspected appendicular mass were excluded from the study. Both operative techniques and their merits and demerits were explained to all the patients and, depending upon their choice or by a simple flip of a coin, they were operated on by either of the techniques. A well-informed written consent was also taken from every patient. The results of both the groups were collected on a proforma and were compared in terms of cosmesis, total operative time, operative and postoperative complications, and total duration of hospital stay. RESULTS: The mean operating time was much shorter in group B (p < 0.001), compared to group A patients. The incidence of postoperative infection was comparatively higher in OA, compared to VAECA. The rate of operative complications (p < 0.001), postoperative complications (p < 0.01), and duration of hospital stay (p < 0.001) were all significantly lower in the VAECA group. Cosmetic results were excellent in VAECA, compared to OA, as assessed by length of incision and the postoperative scar formation. CONCLUSION: VAECA can be a good alternate option in simple cases without much adhesions or mass formation.

A comparative analysis between non-mesh (Bassini's) and mesh (Lichtenstein) repair of primary inguinal hernia.

BACKGROUND: The groin hernia repair is one of the common operations in general surgery. The optimum repair method is under debate and the best mode of repair is yet to be decided. This study is conducted to compare the results of open non-mesh (Modified Bassini's) and Lichtenstein's mesh repair of primary inguinal hernia in terms of recurrence, postoperative complications and quality of life in the long-term. METHODS: This retrospective comparative analytical study includes 840 patients of which 40 patients were excluded from the study due to various reasons. The remaining 800 patients with unilateral primary inguinal hernia, above 16 years of age, operated during January 2000 to December 2007 in a teaching hospital are included in the study. Of the total number, 392 patients (49%) underwent Lichtenstein mesh repair, while remaining 408 patients (51%) were operated by modified Bassini's suture technique. Follow up was conducted 1, 5, 8 and 15 days; 1, 2, 6, 24 and 36 months. RESULTS: The recurrence rate and postoperative pain were significantly low in Lichtenstein mesh repair compared to open non-mesh repair by modified Bassini's technique (p < 0.001). Recurrence occurred in 8 (2.0%) out of 392 patients those with Lichtenstein mesh repair. On the other hand 29 (7.1%) patients with Bassini's repair reported recurrence within 3 years time. CONCLUSION: Mesh repair of inguinal hernia is much superior to non-mesh repair in terms of recurrence and postoperative chronic pain.

Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat.

BACKGROUND: Despite improvement in the technique and increasing experience, complications of different nature and severity continue to occur during laparoscopic cholecystectomy all around the world. We present bile duct injuries in this series with regards to the incidence, severity and management of this problem. STUDY DESIGN: Descriptive. PLACE AND DURATION: Department of surgery, Liaquat University of medical and Health Sciences, Jamshoro and other private hospitals at Hyderabad city during April 2003 to December 2007. MATERIALS AND METHODS: A total of 1132 patients with symptomatic gallstone disease were included in the study regardless of their age and gender. Laparoscopic cholecystectomy by classical four-port technique performed in all cases with few amendments as per situation. Patients with growth in gallbladder and with severe associated medical or cardiac problems were excluded from the study. Details of every patient collected on a proforma and data finally analyzed on SPSS version 10. RESULTS: Of total 1132 patients, 1088 (96%) were females and 44 (4%) were males with a mean age of 47.64 years. Elective laparoscopic cholecystectomy was performed in 1118 (98.7%) patients whereas emergency laparoscopic cholecystectomy was done in 14 (1.23%) patients. Various types of common bile duct injuries as well as post -operative bile leaks and their management is discussed with a view to improve upon the technique and out come. CONCLUSION: Iatrogenic biliary injuries continue to occur despite tremendous overall improvement in technique and expertise.

Small bowel perforations due to deliberate ingestion of injurious foreign bodies--a personal experience.

Ingestion of foreign bodies is not an uncommon problem in our society. The patients usually ingest different types of foreign bodies either accidentally or deliberately. Rare in children but adults are not uncommonly affected and are either psychiatric patients or ingest foreign bodies accidentally. Life threatening complications may occur at times due to ingestion of sharp and pointed objects. An interesting case of ingestion of multiple injurious foreign bodies presenting with multiple small intestinal perforations is presented with review of literature.

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OBJECTIVE: To deteremine the incidence, nature and management of extra-biliary complications of laparoscopic cholecystectomy. MATERIALS AND METHODS: This study presents a retrospective analysis of extra-biliary complications occuring during 1046 laparoscopic cholecystectomies performed from August 2003 to December 2006. The study population included all the patients with symptomatic gallstone disease in whom laparoscopic cholecystectomy was performed. The extra-biliary complications were divided into two distinct categories: (i) Procedure related and (ii) Access related. RESULTS: The incidence of access-related complications was 3.77% and that of procedure-related complications was 6.02%. Port-site bleeding was troublesome at times and demanded a re-do laparoscopy or conversion. Small bowel laceration occurred in two patients where access was achieved by closed technique. Five cases of duodenal and two of colonic perforations were the major complications encountered during dissection in the area of Calot's triangle. In 21 (2%) patients the procedure was converted to open surgery due to different complications. Biliary complications occurred in 2.6% patients in the current series. CONCLUSION: Major extra-biliary complications are as frequent as the biliary complications and can be life-threatening. An early diagnosis is critical to their management.

Laparoscopic cholecystectomy in the elderly patients. An experience at Liaquat University Hospital Jamshoro.

BACKGROUND: Advancing age with its associated co-morbidities increases the likelihood of postoperative complications as well as conversion rate during laparoscopic cholecystectomy. Recent studies have also questioned efficacy of this procedure in geriatric patients. The present study assesses the safety and applicability of laparoscopic cholecystectomy in geriatric patients. The objective of the present study was to asses safety and applicability of laparoscopic cholecystectomy in the elderly patients of 65 years and above. METHODS: This is a prospective analysis of 173 patients, over 65 years of age, who underwent laparoscopic cholecystectomy from December 2002 to November 2006 at Liaquat University Hospital, Jamshoro. Patients presenting with complicated and uncomplicated gallstone disease were included in the study population and all of them were operated laparoscopically. The data included demographic details, co-morbidities, underlying biliary pathology, indications for surgery, operative and postoperative complications, morbidity and mortality, and hospital stay. The statistical analysis of the data performed on SPSS version 10. RESULTS: Laparoscopic cholecystectomy undertaken in 173 elderly patients with a mean age of 69.72 years, out of whom 52 (30.05%) were males and 121 (69.94%) were females. Co-morbid conditions were identified in 53.17% (n = 92) patients and included hypertension in 38 patients (21.96%), Diabetes Mellitus in 23 patients (13.29%), COPD in 19 (10.98%) patients, Coronary artery disease in 9 (5.20%) and cardiac arrhythmias in 3 (1.73%) patients. Indications for surgery included simple biliary colic in majority of patients (69.94%) and complicated stone disease in 52 (30.05%) subjects. There were 37 (21.38%) emergency laparoscopic cholecystectomies and 136 (78.61%) patients were operated electively. Mean operative time was 100 minutes with a SD 29.03. Fourteen (8.09%) patients required conversion to OC (Open Cholecystectomy) due to various reasons. Mean hospital stay was 6.28 days. Overall 23 (13.29%) patients developed postoperative complications. One patient died of acute MI on 2nd postoperative day. CONCLUSION: There is no undue risk in laparoscopic cholecystectomy in the elderly population and the procedure can be regarded as safe as in patients below 65 years of age.